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Hot Flashes: What Can I Do?

Hot flashes, a common symptom of the menopausal transition, are uncomfortable and can last for many years. When they happen at night, hot flashes are called night sweats. Some women find that hot flashes interrupt their daily lives. The earlier in life hot flashes begin, the longer you may experience them. Research has found that African American and Hispanic women get hot flashes for more years than white and Asian women.

You may decide you don't need to change your lifestyle or investigate treatment options because your symptoms are mild. But, if you are bothered by hot flashes, there are some steps you can take. Try to take note of what triggers your hot flashes and how much they bother you. This can help you make better decisions about managing your symptoms.

Lifestyle Changes to Improve Hot Flashes

Before considering medication, first try making changes to your lifestyle. Doctors recommend women make changes like these for at least 3 months before starting any medication.

If hot flashes are keeping you up at night, keep your bedroom cooler and try drinking small amounts of cold water before bed. Layer your bedding so it can be adjusted as needed. Some women find a device called a bed fan helpful. Here are some other lifestyle changes you can make:

Dress in layers, which can be removed at the start of a hot flash.

Carry a portable fan to use when a hot flash strikes.

Avoid alcohol, spicy foods, and caffeine. These can make menopausal symptoms worse.

Try mind-body practices like yoga or other self-calming techniques. Early-stage research has shown that mindfulness meditation, yoga, and tai chi may help improve menopausal symptoms.

What Is Relaxation Breathing?

Deep breathing, relaxation breathing, and paced respiration all refer to a method used to reduce stress. It involves breathing in (inhaling) deeply and breathing out (exhaling) at an even pace. Do this for several minutes while in a comfortable position. You should slowly breathe in through your nose. With a hand on your stomach right below your ribs, you should first feel your stomach push your hand out, and then your chest should fill. Slowly exhale through your mouth, first letting your lungs empty and then feeling your stomach sink back. You can do this almost anywhere and several times during the day, whenever you feel stressed. You can also try this if you feel a hot flash beginning or if you need to relax before falling asleep.

Medications: Non-Hormone Options for Treating Hot Flashes

If lifestyle changes are not enough to improve your symptoms, non-hormone options for managing hot flashes may work for you. They may be a good choice if you are unable to take hormones or if you are worried about their potential risks.

The U.S. Food and Drug Administration (FDA) has approved the use of paroxetine, a low-dose selective serotonin reuptake inhibitor (SSRI) antidepressant, to treat hot flashes. Researchers are studying the effectiveness of other antidepressants in this class.

Women who use an antidepressant to help manage hot flashes generally take a lower dose than people who use the medication to treat depression. Side effects depend on the type of antidepressant you take and can include dizziness, headache, nausea, jitteriness, or drowsiness. As with any medication, talk with your doctor about whether this is the right medication for you and how you can manage any possible side effects.

Medications: Treating Hot Flashes and Night Sweats with Hormones

Some women may choose to take hormones to treat their hot flashes. A hormone is a chemical substance made by an organ like the thyroid gland or ovary. During the menopausal transition, the ovaries begin to work less and less well, and the production of hormones like estrogen and progesterone declines over time. It is believed that such changes cause hot flashes and other menopausal symptoms.

Hormone therapy steadies the levels of estrogen and progesterone in the body. It is a very effective treatment for hot flashes in women who are able to use it. There are risks associated with taking hormones, including increased risk of heart attack, stroke, blood clots, breast cancer, gallbladder disease, and dementia. The risks vary by a woman's age and whether she has had a hysterectomy. Women are encouraged to discuss the risks with their healthcare provider.

Women who still have a uterus should take estrogen combined with progesterone or another therapy to protect the uterus. Progesterone is added to estrogen to protect the uterus against cancer, but it also seems to increase the risk of blood clots and stroke. Hormones should be used at the lowest dose that is effective for the shortest period of time possible. (See What Are the Risks of Using Hormones for Hot Flashes?)

Some women should not use hormones for their hot flashes. You should not take hormones for menopausal symptoms if:

You have had certain kinds of cancers, like breast cancer or uterine cancer

You have had a stroke or heart attack, or you have a strong family history of stroke or heart disease

You have had blood clots

You have had problems with vaginal bleeding or have a bleeding disorder

Should I Take Hormones for My Hot Flashes?

Talk with your doctor before using hormones to treat menopause symptoms. Hormones should be used at the lowest dose and for the shortest period of time they are effective.

Hormones can be very effective at reducing the number and severity of hot flashes. They are also effective in reducing vaginal dryness and bone loss.

Hormone treatments (sometimes called menopausal hormone therapy) can take the form of pills, patches, rings, implants, gels, or creams. Patches, which stick to the skin, may be best for women with cardiac risk factors, such as a family history of heart disease.

There are many types of hormones available for women to treat hot flashes. These include estradiol, conjugated estrogen, selective estrogen receptor modulators (SERMs), and compounded or synthetic hormones. It is a common misconception that synthetic ("bioidentical") hormones mixed by a compounding pharmacist are safer and less risky than other hormone therapies. This is not the case. We must assume they have the same risks as any hormone therapy.

Some of the relatively mild side effects of hormone use include breast tenderness, spotting or return of monthly periods, cramping, or bloating. By changing the type or amount of the hormones, the way they are taken, or the timing of the doses, your doctor may be able to help control these side effects or, over time, they may go away on their own.

This study raised significant concerns at the time and left many women wary of using hormones.

However, research reported since then found that younger women may be at less risk and have more potential benefits than was suggested by the WHI study. The negative effects of the WHI hormone treatments mostly affected women who were over age 60 and post-menopausal. Newer versions of treatments developed since 2002 may reduce the risks of using hormones for women experiencing the menopausal transition, but studies are needed to evaluate the long-term safety of these newer treatments.

If you use hormone therapy, it should be at the lowest dose, for the shortest period of time it remains effective, and in consultation with a doctor. Talk with your doctor about your medical and family history and any concerns or questions about taking hormones.

Buyer Beware: Unproven, Nonscientific "Treatments" for Hot Flashes

You may have heard about black cohosh, DHEA, or soy isoflavones from friends who are using them to try to treat their hot flashes. These products are not proven to be effective, and some carry risks like liver damage.

Phytoestrogens are estrogen-like substances found in some cereals, vegetables, and legumes (like soy), and herbs. They might work in the body like a weak form of estrogen, but they have not been consistently shown to be effective in research studies, and their long-term safety is unclear.

At this time, it is unknown whether herbs or other "natural" products are helpful or safe. The benefits and risks are still being studied. Always talk with your doctor before taking any herb or supplement to treat your hot flashes or other menopausal symptoms.

Other Menopause Symptoms and Treatments

For most women, hot flashes and trouble sleeping are the biggest problems associated with menopause. But, some women have other symptoms, such as irritability and mood swings, anxiety and depression, headaches, and even heart palpitations. Many of these problems, like mood swings and depression, are often improved by getting a better night's sleep. Discussing mood issues with your doctor can help you identify the cause, screen for severe depression, and choose the most appropriate intervention. For depression, your doctor may prescribe an antidepressant medication.

If you want to change your lifestyle to see if you can reduce your symptoms, or if you decide any of your symptoms are severe enough to need treatment, talk with your doctor.

Treating Menopause Symptoms: What's Right for Me?

Deciding whether and how to treat the symptoms of the menopausal transition can be complicated and personal. Discuss your symptoms, family and medical history, and preferences with your doctor.

No matter what you decide, see your doctor every year to talk about your treatment plan and discuss any changes you want to make.